Changes in Sexual Behavior and STI Diagnoses Among MSM Initiating PrEP in a Clinic Setting
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We examined changes in sexual behavior and sexually transmitted infection (STI) prevalence among 183 men who have sex with men (MSM) initiating pre-exposure prophylaxis (PrEP) at an STD Clinic in Seattle, WA. We used generalized estimating equations to measure changes in sexual behavior during PrEP use, and linked PrEP patient data with STI surveillance data to compare the prevalence of chlamydia, gonorrhea, and early syphilis in the periods prior to and during PrEP use. Reporting never using condoms in the prior 30 days increased (adjusted relative risk = 1.46; 95% confidence interval 1.13, 1.88) at 12 months after PrEP initiation compared to the initial PrEP visit. Reporting unknown status partners in the prior 30 days decreased at 12 months compared to the initial PrEP visit, but there was no change in number of sexual partners or reporting HIV-positive or HIV-negative partners. The percentage of patients diagnosed with any STI while using PrEP (49.2%) was higher than the percentage diagnosed in the 12 months prior to PrEP use (35.0%), likely driven in part by increased STI screening during PrEP use. Among MSM on PrEP, we observed decreases in condom use, and a higher prevalence of STIs during PrEP use compared to prior to PrEP initiation.
KeywordsMen who have sex with men HIV Pre-exposure prophylaxis Sexually transmitted infections Sexual behavior
We wish to thank the staff at the PHSKC STD Clinic, including C. Malinski, G. Afful, M. Barry, S. Herrmann, N. Ocbamichael, C. Thibault, D. Spellman, and J. Dimer. This work was funded by Public Health – Seattle and King County; the National Institutes of Health (NIH) [F31 MH114892 trainee support to MAM, and K23 AI113185 to LAB]; and the University of Washington Center for AIDS Research, an NIH-funded Program [P30 AI027757] which is supported by the following NIH Institutes and Centers: National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institutes of Mental Health, National Institute on Drug Abuse, National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, and National Institute on Aging.
Compliance with Ethical Standards
Conflict of interest
CMK, MRG, LAB and LEM have received donations of specimen collection kits and reagents from Hologic, Inc. unrelated to this work. LEM has received speaker’s fees from Hologic, Inc. unrelated to this work. JCD has conducted studies unrelated to this work funded by grants to the University of Washington from Hologic, Curatek, and Quidel, and has received a speaker’s honorarium and travel support for a meeting on retention in HIV care from Gilead. MRG has received research support from GlaxoSmithKline. MAM, SD, and AD declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study formal consent is not required.
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